title: Characteristics of patients with type 2 diabetes mellitus in two rural, medically underserved communities.
abstract: In the state of Hawai'i, Native Hawaiians and Filipinos suffer from increased disparities, compared to other groups, in diabetes prevalence and adverse health outcomes that are exacerbated by challenges to health care access among rural communities. To address the limited literature describing rural, underserved patients with diabetes in Hawai'i, this paper aims to characterize two rural communities that are located on Moloka'i and Lana'i in federally-designated medically underserved areas and that are served by a single Native Hawaiian health care system entitled Na Pu'uwai. Descriptive analyses examining associations between variables were performed using the baseline demographic information, clinical measures, and questionnaire responses collected from 40 adult study participants with diabetes. The data revealed that the study participants had a high prevalence of insulin use (60%); a HbA1c level greater than or equal to 9% (55%); a high-fat diet (73%); and comorbidities, including hyperlipidemia (85%), hypertension (83%), and obesity (70%). Furthermore, among the participants, the mean SF-12v2™ General Health Perceptions Score was significantly lower for participants with uncontrolled diabetes compared to those with controlled diabetes (P = .02); however, this association was not statistically significant in the multivariable regression model that adjusted for age and number of diabetes medications. Based on these results, the participants appear to belong to a high-risk group with a complicated manifestation of diabetes. This study adds to the growing body of literature demonstrating disparities in diabetes among rural, minority, and underserved communities, highlighting the need for further investigation, development, and implementation of strategies for reaching these vulnerable populations.
authors.affiliation: University of Hawai'i, Center for Native and Pacific Health Disparities Research, Department of Native Hawaiian Health, John A. Burns School of Medicine, Honolulu, HI, USA.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Ko
authors.forename: Rebecca
authors.initials: R
authors.lastname: Delafield
authors.forename: Jim
authors.initials: J
authors.lastname: Davis
authors.forename: Marjorie K
authors.initials: MK
authors.lastname: Mau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D059305:Diet, High-Fat / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006254:Hawaii / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin
keywords: Adult; Diabetes Epidemiology; Diabetes Mellitus; Hawai‘i; Health Status Disparities; Healthcare Disparities; Minority Health; Rural Health; Type 2